Healthy Food in  Health Care: A Menu of Options: Healthy Food in Health Care: A Menu of Options Tuality Food Committee Meeting February 8, 2007 Neha Patel, MS HCWH Program Director Oregon Center for Environmental Health


What is Hospital Food?: What is Hospital Food? Below is a list of foods that were among the most ordered in 2005 reported by the OHSU food and nutrition department: 325,000 slices of Bacon 498,000 servings of mashed potatoes 155,000 cookies 142,000 hamburgers 187,500 slices of Pizza


Obesity in Context: Obesity in Context


From our Farms of 60 years ago…: From our Farms of 60 years ago…


To our Current System of Industrial Agriculture: To our Current System of Industrial Agriculture


Healthy Food in Healthcare: Healthy Food in Healthcare Health Care Without Harm is working with hospitals to adopt food procurement policies that: provide nutritionally improved food for patients, staff, visitors, and the general public, and create food systems which are ecologically sound, economically viable, and socially responsible. By adopting food procurement policies that are ecologically sound, economically viable, and socially responsible, health care systems demonstrate an understanding of the inextricable links between human, public, and ecosystem health.


Sustainable Food Defined…: Sustainable Food Defined… A sustainable food system is one in which the environmental, social, and economic impacts of our decisions both sustain the needs of the current generation and allow for future generations to do the same.  Sustainable foods are: Produced, processed, stored and transported with the minimization of non-renewable energy use Produced and handled in a way that supports strong regional economies Healthy as part of a balanced diet and not containing harmful biological or chemical contaminants Fairly or cooperatively traded between producers, processors, retailers, and consumers


Sustainable Food Defined…: Sustainable Food Defined… Non-exploiting of employees in the food sector in terms of rights, pay and conditions Environmentally beneficial or benign in production and processing Accessible both in terms of geographic access and affordability High animal welfare standards in both production and transport Socially inclusive of all people in society Encouraging knowledge and understanding of food and food culture


Healthy Food in Health Care: Healthy Food in Health Care A variety of health care institutions across the U.S. have begun to adopt programs, practices, and policies to support a healthy food system. Your facility can choose one, a few or all of the following recommendations that will improve the quality of the food choices in your hospital.


Start a Conversation About Healthy Food : Start a Conversation About Healthy Food Create a multi-disciplinary food committee or “team” composed of staff from: Food and nutrition services; Purchasing; Administration; Nursing, and clinicians; Other - public affairs, ethics and quality improvement personnel. Take the responsibility to explore a new understanding of healthy food and how institutions can support food production that is socially responsible, economically viable and environmentally sustainable.


Menu of Options: Steps to Healthier Food in Hospitals : Menu of Options: Steps to Healthier Food in Hospitals Antibiotic-free meat/poultry rBGH-free milk Organic and other certified foods Certified coffees Locally-sourcing food Fast-food free zone Farmers’ markets Hospital gardens Compost and reduction of food waste Hospital food policy Vending machine use


Use of Non-therapeutic Antibiotics in Agriculture: Use of Non-therapeutic Antibiotics in Agriculture Antibiotic resistant bacteria are an increasing concern to health care professionals. Antibiotic overuse in food animals contributes to resistance transmitted to humans. Approximately 70% of all antibiotics are given to animals for non-therapeutic purposes: to promote growth; to prevent infections common in industrialized and confined livestock and poultry facilities.


Purchase Meat/Poultry Raised Without Non-therapeutic Antibiotics : Purchase Meat/Poultry Raised Without Non-therapeutic Antibiotics Purchase only meat/poultry raised without the use of non-therapeutic antibiotics. Communicate to your Group Purchasing Organizations (GPOs) a preference for buying meats produced without antibiotic feed additives given to animals in the absence of diagnosed disease.


Deaconess Billings: Antibiotic-free turkey: Deaconess Billings: Antibiotic-free turkey Billings Clinic, Billings Montana Longstanding contract with Seder Ridge Turkey Farms to purchase locally produced, free-range turkey without antibiotics In 2001, hospital’s contract with Sodexho ended hospital’s purchases from Seder Ridge After pressure from the board and the community, hospital worked with Sodexho to reinstate Seder Ridge as a supplier for the cafeteria and inpatient meals.


Use of rBGH in Milk Production : Use of rBGH in Milk Production Recombinant Bovine Growth Hormone (rBGH, also know as rBST). Banned in Canada, Australia, New Zealand, Japan, and all 25 nations of the European Union. Given to dairy cows to increase milk production over longer periods of time. Results in increased udder infections (necessitating the use of antibiotics) and the risk of other adverse health effects in cows. Treatment with rBGH also increases levels of growth factor (IGF-1) found in milk - has raised concerns about human health effects.


Purchase Milk Produced Without rBGH : Purchase Milk Produced Without rBGH There are two categories of non-rBGH milk: Organic - in addition to being rBGH-free, also prohibits the use of pesticides in feed and antibiotic use in cows Non-organic - allows the use of pesticides and antibiotics and can be similarly priced to conventional milk. Work with your GPO and your distributor to purchase rBGH-free milk. Ask suppliers for availability and verification methods for rBGH-free dairy products.


Organic and Other Certified Food : Organic and Other Certified Food “Organic” label means: Produced under certain conditions, Without synthetic pesticides, hormones or antibiotics, and Certified by the USDA or an independent third party. Purchasing certified organic may: Improve the health of patients; Help protect agricultural workers; Protect our air and water; and Create a market that supports healthy, environmentally-friendly growing practices.


Preferring Organic and Other Certified Food : Preferring Organic and Other Certified Food Identify the criteria your institution will use as priorities in food purchasing.


Cancer Treatment Centers of America: Reducing Exposures, Going Organic: Cancer Treatment Centers of America: Reducing Exposures, Going Organic Cancer Treatment Centers of America (CTCA) Created a certified-organic purchasing preference for two inpatient facilities; Zion, Illinois and Tulsa, Oklahoma Zion facility serves organic fruits and vegetables, soy milk, dairy products, dry goods, and meats when available. Sources some produce from local cooperative, Roots and Fruits Cooperative. Nutritionists also counsel patients to purchase organic food for home consumption during outpatient treatment.


Coffee : Coffee Coffee is the U.S.’s largest food import and second most valuable commodity after oil. Most coffee is grown in developing countries under conditions that require clear-cutting and heavy use of pesticides and where agricultural workers are often underpaid.


Purchase Certified Coffee : Purchase Certified Coffee Many different types of certified coffee that can address these issues, like fair trade, shade-grown and organic. Buying certified coffee supports community development, health, and environmental stewardship.


Cooley-Dickinson’s “Way Cooley Coffee”: Cooley-Dickinson’s “Way Cooley Coffee” Cooley-Dickinson Hospital in Northampton, MA In 2004 initiated a program, “Way Cooley Coffee” in conjunction with local fair-trade certified coffee roaster Way Cooley Coffee, 100% fair-trade and organic, is served in the coffee shop, cafeteria and patient floors, as well as is for sale in the gift shop. Money generated from the sale of the coffee increases the hospitals support for Hampshire HealthConnect, a program that links uninsured people with health coverage and care.


Benefits of Locally-sourced Food : Benefits of Locally-sourced Food Supporting locally-sourced food systems avoids long distance travel; overuse of plastics packaging; and chemical preservatives required for transporting food long distances. Reduces the massive fuel consumption and air and water pollution associated with long-distance transport. Helps to build relationships between the urban and rural community and supports the local economy.


Buy from Local Producers : Buy from Local Producers Learn what locally-produced foods your vendor currently provides. Express a preference for purchasing fresh, locally grown, and sustainable food from your vendors. Investigate the percentage of foods that can be purchased outside your vendor contract. When your contract is up for renewal, use this as a time to negotiate the off-contract percentage purchases.


Sutter Maternity and Surgery Centerbuys fresh, local and organic: Sutter Maternity and Surgery Center buys fresh, local and organic Sutter Maternity and Surgery Center, Santa Cruz, CA Small specialty hospital Chef and Food Service Director work together to create menus and source fresh locally-grown foods including breads, meats, fruits and vegetables Partnership with Agriculture and Land-based Training Association (ALBA) to purchase locally-sourced, organic produce year-round – food from ALBA is purchased off vendor contract


Become a Fast-food Free Zone : Become a Fast-food Free Zone Of its 13,000 U.S. locations, about 30 McDonald's outlets are in hospitals, including children's hospitals in Los Angeles and Philadelphia. (Washington Post, Dec 2004) Review the food service operations of the hospital - patient food, cafeteria food, catering, vending machines and coffee carts; Evaluate whether food choices are consistent with the promotion of health dietary patterns for patients, staff and the larger community and create criteria that support healthy eating. Require food service operations and distributors meet the criteria set forth by the hospital - those that do not can be removed and replaced.


Limit Unhealthy Snack Choices in Vending Machines: Limit Unhealthy Snack Choices in Vending Machines Evaluate your use of vending machines so that food offered is consistent with dietary recommendations for healthy snacking. Offer snacks like whole fruit, low fat and low sugar snacks, and water or juice beverages. Draft a policy that outlines the types of food that would be acceptable in vending machines (i.e. no trans-fat, low in processed sugars and fats, no artificial ingredients, and no preservatives) Outline food packaging standards and energy efficiency of machines. Use these criteria in negotiations when vending machine contracts come up for review. Morry Gash / AP file


Kaiser Permanente Roseville Medical Center - Roseville, CA: Kaiser Permanente Roseville Medical Center - Roseville, CA Facility is participating in a pilot study to replace 75% of the foods and drinks in their vending machines with healthier choices Healthy Picks, a Kaiser Permanente-wide program aimed at offering more healthy food options to members, physicians and staff Healthier foods and drinks that meet pre-determined criteria for lower fat, calories, sodium, and sugar


Farmers’ Markets: Farmers’ Markets On-site farmers’ markets and farm stands Provide fresh produce to staff, visitors, and patients. Support efforts to incorporate healthy foods into diets by increasing availability of fresh, locally-grown foods. Generate goodwill in a community, support local growers, and create new community partnerships. Can be authorized to accept food stamps and WIC coupons, thereby increasing accessibility to healthy food in low-income populations. © 2003 by James Martin


Hospital Gardens: Healthy Foods and Thriving Green Spaces: Hospital Gardens: Healthy Foods and Thriving Green Spaces Help to foster a sense of community and pride in hospital staff and offer a place of respite for patients and staff. Serve as demonstration gardens to educate the community about organic growing methods, integrated pest management, and the variety of foods that can be cultivated in a small urban space. Vegetable gardens can produce healthy food for patient or cafeteria menus. Cut flowers can be sold or used in your facility.


Dominican Hospital’s Garden Catholic Healthcare West, Santa Cruz, CA: Dominican Hospital’s Garden Catholic Healthcare West, Santa Cruz, CA The hospital garden idea grew from a conversation between the storeroom coordinator and the grill chef for the Dominican Food Services The garden, starting at 1000 sq. ft. with plans for expansion, now supplies the cafeteria with fresh seasonal foods and herbs featured in the daily menu A local high school participates in care for the garden – many of the supplies, funds and labor for the project have been donated


Compost, Divert and Reduce Food Waste : Compost, Divert and Reduce Food Waste Space limitations will dictate what type of composting method a health care facility can adopt. While not strictly “food waste,” the purchase of recycled napkins, the use of paper or compostable dish ware for “take-out,” and recycling of kitchen cans and bottles are other ways in which hospitals are improving their environmental performance. Limited space - food waste picked up by local haulers and sent to off-site composting facilities or used as animal feed. More space - compost waste on site using an in-vessel composting unit.


OHSU’s food composting program: OHSU’s food composting program In the four months that OHSU’s compost has been up and running, the hospital has already documented a 50% reduction in solid waste coming out of food services, up to 80% in water savings resulting in cost savings.


Establish a Hospital Food Policy : Establish a Hospital Food Policy Develop a broad, integrated food policy that can then guide your facility’s future efforts. Health care facilities and systems can play an important role in supporting the health of their staff, patients, and local and global communities by understanding that healthy food includes more than nutritional quality.


Oregon Healthy Food in Healthcare: Oregon Healthy Food in Healthcare In January, 2006 the Center convened a roundtable made up of representatives food services representatives from five of the state’s largest health systems and proponents of sustainable agriculture. NEXT ROUNDTABLE- Feb. 15th Case Studies Barriers Brainstorm Next Steps Develop Working groups


Healthy Food in Healthcare Pledge: Healthy Food in Healthcare Pledge By supporting the Healthy Food in Health Care Pledge facilities are demonstrating leadership by sending an important signal to the marketplace and policy makers about their interest in local, nutritious, sustainable food and importantly, beginning to model healthy food practices in a ongoing stepwise fashion. Oregon Hospitals – Kaiser, OHSU and Good Shepherd Healthcare were among the first adopters


Good Shepherd leading the way: Good Shepherd leading the way Replacing processed food Scratch cooking Improved staff morale Inventory Bottom Line: Food/supply cost/meal reduced by 12% 9% achieved through waste reduction. 3% achieved through scratch cooking, reducing inventory, and reduction of disposables.


Create Healthy Food…: Create Healthy Food… Grow Healthy People!


Resources: Resources Health Care Without Harm –www.noharm.org/food/issue Hospitals for a Healthy Environment - www.h2e-online.org Oregon Center for Environmental Health –www.oregon-health.org.org Green Guide For Healthcare –www.gghc.org Special Thanks to SF PSR for providing content for today’s Presentation. http://www.sfbaypsr.org/